What I wanted doesn’t matter

There’s a place for discussion about birth options for pregnancies that aren’t high risk, and this is not it. If you’re tempted to make this space or my loss a platform, don’t. You won’t be helping anyone, and you’ll only succeed in hurting people who are hurting enough already.

In addition to all the other reasons the home/hospital, assisted/unassisted birth debate often feels so ugly to me (hatefulness and blame being the primary problems), there’s an additional and selfish reason it all makes me so sad. It’s completely irrelevant for me. I most certainly did not and do not have a choice about where to give birth. All I want is to be totally aware during labor and I want to be okay enough to participate fully in the first few minutes of my child’s life. But I know there’s a very good chance I won’t even be able to do that.

As painful and terrifying as it was, I am grateful that I knew what was going on every moment during labor and Natan’s short little life; even during the hallucinatory phase I somehow knew what was happening in reality. And when it happened, no one had to tell me Natan had died. The fact that it was all in a cold hospital made no difference. With only a few exceptions, the doctors and nurses at the hospital were very kind and concerned about my comfort and mental well being. Thus, somehow, an exceptionally difficult labor, under clinical and painful circumstances, managed to be a very holistic one.

Regardless of the questionable circumstances that brought my last pregnancy to a crisis point, the hospitalization was not unpleasant for any reason beyond the obvious – I shouldn’t have needed to be there and who could possibly be happy to lie in a hospital bed for days on end? And I don’t doubt that the hospital staff prioritized and cared for my son and me.

My biggest concern in this next pregnancy is bringing the baby home alive, and I will honestly do whatever my doctors feel might help me do that. Not that I am complacent, taking a cue from Mary, I confessed to my doctor last week that I was not feeling up to dealing with the normal spotting that happens after a pap smear during pregnancy. She agreed, without argument, to use a different instrument and scrape only around the cervix. It didn’t hurt, I didn’t spot, and I felt really happy with myself for speaking up because it hadn’t occurred to me that I could. Obviously, I know I can refuse any procedure, but I worried about how it would go over. Dr. K, though, seemed to completely understand and didn’t lecture me about why women need pap smears. But when it comes to labor, and all of the unpleasant things I’ll go through if I make it beyond 12 weeks, I really only care about making sure the baby survives, however that needs to happen.

I’m not saying, by any measure, that that’s not what’s most important to any other mother. But as many of us have said, the idea that we would make it into the second trimester and not have a living baby to show for it never occurred to us. And the truth is, it’s not a likely possibility for any mother. Thus the debate about how and where to give birth now feels like an irrelevant luxury, because I am now part of that tiny statistical category of women for whom pregnancy is high risk. And I’m mourning my departure from the low-risk category.

I live among people who talk a lot about the over-medicalization of pregnancy and childbirth, and who lament the frequency of c-section and use of pain medication in labor. I can say – if I have a vaginal birth and if my doctor feels it’s safe – I will still do without the latter. I’ve already done it, and although Natan was still small, I was incredibly calm about being handled, cut, and probed when it was for a good cause. Pain that isn’t dangerous doesn’t concern me at all.

But the idea that I will even have that little choice seems so remote to me now. All that I care about, beyond bringing this baby home alive, is that I know every moment what is happening to my baby and that I be part of every step of his/her care. That’s my second goal in this pregnancy, and I’m scared that even if the first is possible, the second might prove out of my hands. I was about to write that I only desire not to have a c-section, but I think desire is too strong of a word. I just hope I don’t need one, and that’s really the only active thought I have about my choices.

Romantic stories about childbirth scare me – stories about babies being born in cars on highways or at home because mothers didn’t have time to get to the hospital. I thank goodness I live five minutes from a Level III hospital, because what if that had been me? I’d been in the hospital more than a week when Natan died, but what if I’d gotten stuck in traffic when labor started the first time, panicking and with no one to stop it?

The debate about childbirth feels like a luxury. The statement that our bodies know what to do, because it is usually true, makes me feel like a freak. Women who are so much less knowledgeable about their bodies, who took so much less care to have a safe and healthy pregnancy, manage to easily do what I failed at. And now, I feel like I could never engage in a discussion about pregnancy again that is colored by anything but trauma and fear. And part of me is really quite sad about that.

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17 responses to “What I wanted doesn’t matter”

I am a bit reluctant to comment but since I have given your post some thought, I might as well share it for what it is worth. Every choice we make sets into motion a set of circumstances that we might or might not have any influence or control over. Even a non-choice is a choice. Every choice has risks that we live with but may not always be willing or able to accept. We are responsible for our choices but not always the outcome(s) because we may not have any control over the circumstances that follow the choice. One cannot control for all the variables life provides. We live to make choices; to risk even when we know that the odds maybe stacked against us. Why? Because we believe in hope of what can be with all its possiblities and more. The very survival of the human race depends upon the hope that we can procreate.

You are no freak Sara just because your body might act differently than someone elses. I hope you have a full-term normal delivery of a healthy baby boy/girl…and I know you will keep us posted 🙂

Sara, I think what you want is what most women want in childbirth, however they go about it–to be included in the decisions, to know that what happens to you is necessary for your health and your child’s, to feel as safe as possible. You’re making decisions about your care now that may impact your labor and delivery later–and the impact could be positive if I understand you. Am I right that if what you’re doing now works, then you carry to term, they remove the cerclage and your delivery need not be any different from a low-risk full-term delivery?

This is coming up for you earlier than most moms because that is what your history dictates. But it sounds like your doctor is supporting you and valuing your judgment, listening and not railroading you. And to me, that’s what’s important.

(For the record, I was a homebirth mom who transferred to hospital for exhaustion. The decision was mine and the right one, but it had consequences such that I would not feel safe if I wound up in the hospital again. But this is me! As a childbirth educator, I know that if the hospital is where you feel safe, the hospital is where you need to be.)

Sara, part of what always make me sad about the debate is that it always includes guilt for women like you and me.

So many people believe that pregnancy and childbirth have to be a zero sum game, where either we agree to accept every technological intervention, which must also be cold and impersonal, or we become completely opposite.

My hospital is always the one I cite as a middle ground. It is a level 3 OB/NICU center that also embraces one to one care and a very warm and low-tech approach. Midwives and Docs both love it, and patients love the way the room looks just like a home. But behind the curtains, if medically necessary, the equipment is there.

And the key is the staff’s willingness not to push women to do things they don’t need. You are high-risk for pregnancy but you may not be for the birth itself. Try not to worry too much.

Thanks, LeRoy. You don’t need to be reluctant to comment. Thanks for having hope for me.

S. & Aurelia, thanks for the positive spin. I’ll try to work on seeing it that way. Should the cerclage and/or the progesterone work and I carry to term, I’ll move down in risk a bit. But since the doctors are still unsure about what happened when my blood pressure crashed and my heartrate shot up (to levels and at a time that aren’t totally attributed to the niphedipine), I’ll probably have to be monitored more closely than a normal risk mother. But fortunately, my hospital is more like the kind Aurelia described. Even in the high-risk section the rooms are rather comfy and the NICU seem private/comfortable to the extent that it can be.

If I have a low-risk labor, I’m actually still hoping to be able to use the jacuzzi bath and birthing bars and balls I can use at the hospital.

Sara- This was a really interesting post. You articulated your feelings beautifully and gave me a lot to think about.

I guess since I ended up needing so much medical assistance to even become pregnant, I gave up a long time ago on the idea that my body “knew what to do.” I think those feelings probably quite naturally extended into pregnancy for me. It never even occurred to me to consider anything other than delivering in a hospital setting.

Your description of how you no longer have the luxury of “debate” reminds me also of similar feelings I have had around fertility. There were so many things that just weren’t an option for us anymore. And anytime I hear someone say that choosing fertility therapy is “selfish”, well… that is hard to hear.

I continue to hope upon hope that this pregnancy goes smoothly for you, and ends joyfully.

I sucks to have options taken away from you, even options you would have chosen not to exercise. When you are forced to accept something, it is hard to own it.

I think that because I had previa with Monkey, I got to re-calibrate the range of my choices and my ownership thereof. I felt that my doctor trusted and respected me, and that I had a strong voice in all the decisions, even though these decisions were from among a very restricted set of options.

I think I am lucky too in that I had a pretty much ideal labor with Monkey. It was in the hospital, but it was unmedicated. I got to use the birthing ball, and really liked it. My hospital is much like Aurelia’s, although not nearly as home-like looking. I am very comfortable there. A’s birth was different, and I made different choices, but again, I couldn’t be more comfortable anywhere else.

Interestingly, there is Another Big Hospital in town, and I wouldn’t go there if you paid me. I had nothing but crappy experiences there whenever I have seen specialists there, and I have yet to hear of someone loving their experience with their delivery at the place. Maybe that also counts as a choice on my internal meter.

I guess what I am trying to say is that I hope you develop the kind of relationship with Dr.K that makes it easier for you to feel ownership of the decisions and brings you peace.

As for feeling like a freak… Yeah, that’s how I felt on the cruise ship, for example, when I saw all the pregnant women there. Maybe more like a buzzkill than like a freak, but same difference.

Maybe I am just used to it, but since I have lived with the absence of choice on so many aspects of preparations for pregnancy, pregnancy, and childbirth for six years now, it doesn’t phase me anymore. When I hear of other people choosing different options, I am sometimes even a little surprised (as if I forget that other options exist), but mostly I have no emotional reaction to other’s choices beyond being glad that other women find things that work for them.

Now, if someone got up in my grill (or even anywhere in my earshot) about how their personal choices are THE way to go for everyone, I make no guarantees. Regardless of which particular set of choices would be advocated for. Just saying.

The statement that our bodies know what to do, because it is usually true, makes me feel like a freak.

If you use generalized terms, then yes, women like us are not “normal.” If you use statistics like 1%, we may even seem like “freaks.” But when you look at the actual numbers…tens of thousands of women sadly stand with us. In this case, when we are talking about human lives, I think generalizations and statistical percentages do a disservice to all women. It only serves to minimize what is a MAJOR problem in our society. But then again, maybe that’s the whole point. Women who feel like freaks are less likely to shout from the rooftops, right? I think maybe that is an attitude that is slowly changing…with the help of smart and eloquent voices like yours.

I agree with Aurelia that it isn’t a zero-sum game. I have been lucky enough to have two non-medicated deliveries in hospital settings and i was overall quite pleased with the care i recieved…even in a hospital which is notoriously ‘interventionist’. Granted they have birthing balls there but those things scare me — i am sure i would fall off!

I feel the exact same way. Even before we lost Elijah, I wasn’t very opinionated about how I was going to deliver, etc. I guess I had chosen to deliver in a hospital and not at home, but mainly just out of plain fear and lack of experience. I do think the choice should be between the parents and the doctor/midwife. And I think until you experience a loss or know of one personally, all the what ifs don’t seem real.

I was on a messageboard recently and responded to a thread about turning down “routine” u/s. I wondered why anyone would turn down an u/s, especially since I’ll be having them every 2-3 weeks for a while, then more often later on. Yeah, u/s aren’t some magical cure-all, and there are other ways to diagnose problems. But then again, you can learn things from an u/s, like if the baby’s growing appropriately, if the blood flow into the placenta is adequate, etc. Really, it all depends on your level of risk, and mine of course is much higher now.

Nevertheless, I wouldn’t judge a woman for turning down an u/s, and hope I won’t be judged for asking for more. All we can do is be informed, advocate for ourselves and our babies, and hope for the best.

It’s a correction/overcorrection thing, isn’t it? Obstetrics tends to overuse technology meant for high-risk pregnancies. Birth activists say “hey, these are being overused and you can say no!” Then the women for whom the technology is appropriate feel bad for not saying no.

In my (currently-on-hold) childbirth ed work I try to be clear that in the phrase “routine interventions” the word that’s a problem is “routine” rather than “intervention.”

Mary J., I realize I responded to your comment indirectly, which isn’t really fair. A “routine” u/s would be one done for no particular diagnostic reason–as opposed to one done for screening purposes, like the anatomy scan at 19 weeks, or one done in reaction to a symptom, like suspected growth problems.

Some docs to an u/s at every visit for every patient “just to see the baby.” (And of course they’ll bill for it.) In this situation, the test won’t affect care and it would be perfectly reasonable to refuse it.

Remarkably, u/s technology hasn’t been proven safe for fetal exposure. We think it’s safe, but we don’t know. It’s not really something I have a soapbox about, since I think it probably isn’t causing harm, but it is part of a history of obstetrics embracing untested technologies that does bother me.

Sara,You’ve done a great job by taking the time to learn about your body and the options you do have. I know it must be frustrating to see and to hear about people to don’t seem to have to do much to have a healthy baby. However, in the end you and your child will come out ahead.

Our bodies do not necessarily know what to do. Everyone has something about them that needs some help to work.

Ask your doctors to talk to a toxicologist and a pharmacology professor (Ph. D.) about the drug reactions. Nifedipine and all other other drugs you were on coupled with the stress you were under can change the way the drugs perform in your body. Medical doctors do not cover what is called pharmacokinetics, which is how drugs move around the body and react with each other. They are just given a list of drug names and symptoms that the drugs treat to memorize.

Unfortunately from what I’ve read, it seems that the obstetricians and the cardiologist cannot seem to get together on how to explain why Nifedipine and many of the tocolytics (drugs that slow down labor) can cause problems like you had. Many of the tocolytics were developed for cardiac problems and there is extensive literature on what can go wrong with these drugs in cardiology. It was a bit scary for me to read some of the obstetric literature on these same drugs because many times these papers and webpages said that certain reactions could not happen, which were well documented in the cardiology literature. It was almost like the OBs were in denial.

With that said, I am not putting down the use of drugs or medical intervention in the birth process. Being a grad student in the sciences, most of my colleagues talk about getting an epidural as soon as possible. There is a fear of c-sections and epsiotomies, but not as much as I’ve seen in my friends outside of the sciences and engineering. Most of my colleagues totally shun home births, although there are exceptions. The ones who want a home birth are usually the ones who had an uneventful labor and delivery in a hospital, but were completely turned off by the way they and their families were treated.

Personally, if my husband and I do have a biological baby of our own and I am healthy enough, I’d like to be able to choose somewhere in between a hospital and a home birthing situation. Looking at my age (soon to be 37) and my family history, I doubt there will be much of a choice.

Mary, I’m so with you on the extra ultrasounds. Although I’m not anxious to have any unnecessary messing around with my cervical area, this wait between ultrasounds is terrifying. If my husband and I weren’t facing a serious & sudden financial problem, I would totally rent a doppler.

Lori, I’ll admit, I used to not understand why women would go to such great extents to conceive, but I wouldn’t have thought it “selfish,” just out of my realm of understanding. Yet I know people say it all the time. It’s hardly as if the way my husband and I have conceived 3 times now was altruistic.

Catherine was right, there are many women like us whose bodies “don’t know what to do.” So why is it I think all of you are normal and I’m the only freak? Only sometimes, though, when I’m sad. Most of the time I’m okay with me.

I was thinking about this and i remembered that Jennifer over at Perfect Work recently wrote a really good post about birth experience etc. Here is the link: Hair Color, On line Games, and Reflecting. Hope that works! She is being induced today,